Human immune deficiency

virus (HIV) infection /AIDS

By
Dr: Murtada Abubaker
Physician
 Contents
 Virology and immunology
 Pathophysiology
 Epidemiology
 Transmission
 Clinical phases of HIV infection
 Diagnosis / Investigations
 Management (prevention &treatment )
 Complications
 Virology and immunology

 HIV virus is RNA virus belong to retrovirus

group .
 HIV virus divided into HIV1 and HIV2
 HIV1 responsible for most HIV infections
 HIV2 cause similar illness,but longer latent
period .
 Pathophysiology of HIV infection
 Once HIV infect a human it attaches to and
enter immune cells that have CD4 protein on
their surface ,mainly CD4 T-lymphocyte and
macrophages .
 With in this cells the virus replicate using
reverse transcriptase and protease enzymes
,producing billion of new virions .these are
released and in turn infect new CD4 +ve cells
depletion or impaired functions of CD4 +ve
cells .
 Epidemiology
 The first AIDS case were recognized in
USA in 1981 .
 Estimated that to date more than 25
million people have died as a result of HIV
infection worldwide .
 Africa has 25% of world disease burden.
 Use of antiviral decrease the infectivity by
96%.
 Transmission
 Potentially infectious body fluids are
(Blood ,Serous effusions ,Cerebrospinal
Fluid, Semen , Vaginal fluids and Breast
milk.)
 Non-infectious fluids unless they are
contaminated with blood e.g Urine ,
Saliva and Vomitus .
 Transmission continue...
 The main routes of HIV transmission are :
 1- unprotected sexual intercourse
 2-Mother to child (during pregnancy ,
during delivery and breast feeding)
 3- Receipt of infected blood products
 4- injections or treatment with unsterile
needles ,syringes or surgical apparatus.
 Needle stick injuries.
 Clinical phases of HIV infection

 Primary infection (serocoversion)

occur 2-6 weeks after exposure to HIV
infection .
Patient may developed transient fever ,
malaise , myalgia , pharyngitis ,
maculopapular rash or
meningoencephalitis .
Asymptomatic infection but about 30% have
persistent generalized lymphadenopathy
(PGL). Defined as lymph node more than
1cm diameter at 2 extra inguinal sites
Persistent for 3 months or longer.
 AIDS related complex : these a collection
of symptoms and signs of fever , night
sweat ,diarrhoea , weight loss ,minor
opportunistic infections e.g oral candid ,
oral hairy leucoplakia ,herpes zoster,
recurrent herpes simplex and Tinea
infection .
 Diagnosis
 Serum HIV by ELISA test confirmed by
western blot
 PCR for HIV RNA or core P24 antigen in
plasma .
 Ora Quick ADVANCE test ; use oral fluid
 Prevention

 Blood screening before donation

 use of disposable syringes and equipment
 Use of antiviral in antenatal for HIV +ve
lady .
 Post exposure prophylaxis.
 Raising the awareness of population
towards the HIV risk .
 Treatment
 Supportive treatment( antipyretic if
febrile , correct anaemia ,treat
concomitant infection , iv fluid if
dehydrated )
 Specific treatment . Anti retroviral drugs if
indicated .
 Complications
 CNS : cerebral toxoplasmosis ,
lymphoma , tuberculoma ,HIV
leukoencephalopathy .
 Eye : CMV retinitis
 Respiratory system : Tuberculosis ,
Pneumocyst carrnii pneumonia
(pneumocystitis jovercies)
 Complications continue

 GIT : oral and oesophageal candidiasis ,

weight loss , hepatomegally , chronic
diarrhoea .
 Kidney : HIV nephropathy
 Skin : Kaposi sarcoma